DoL CA-2 1997 free printable template
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For sale by the Superintendent of Documents U.S. Government Printing Office Washington DC 20402 Form CA-2 Rev. Jan. 1997 Official Supervisor s Report of Occupational Disease Please complete information requested below Supervisor s Report 19. Form CA-7b available from the personnel off ice should be studied BEFORE a decision is made to use leave. 2 Payment of compensation for total or partial wage loss. certain organs members or functions of the body such as loss or loss of use of an arm or...
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How to fill out DoL CA-2
How to fill out DoL CA-2
01
Obtain a copy of the DoL CA-2 form from the appropriate government agency's website.
02
Fill out the employee's personal information at the top of the form, including name, address, and contact details.
03
Describe the nature of the injury or illness clearly and concisely in the relevant section.
04
Provide details about how the injury or illness occurred, including date, time, and location.
05
Include any medical treatment received and the name of the medical provider.
06
Complete the section regarding any witnesses to the event, if applicable.
07
Sign and date the form to certify that all information provided is accurate.
08
Submit the form to the designated office or relevant contact provided in the guidelines.
Who needs DoL CA-2?
01
Employees who have suffered work-related injuries or illnesses that require compensation benefits.
02
Individuals seeking to file a claim for federal workers' compensation under the Department of Labor.
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What is a CA-2 form?
Continuation of Pay. The CA-2 Notice of Occupational Disease form should be used if you have sustained an occupational disease injury on the job. An Occupational Disease is a condition produced in the work environment over a period longer than one work day or shift.
How does Owcp affect retirement?
Q: Does the time on OWCP Federal Workers' Compensation count towards my creditable years of service at retirement? A: Yes! Your time on OWCP will count as creditable years of service towards your retirement.
What is the difference between CA1 and CA2 form?
Most work-related medical conditions fall into two categories: (1) traumatic injury (Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation), and (2) occupational disease (Form CA-2, Notice of Occupational Disease and Claim for Compensation).
What is a CA 3 form?
REPORT. If the employee is receiving disability compensation periodically each four weeks, the official superior should immediately telephone or telegraph the OWCP advising the date employee returned to work. This will avoid an overpayment of compensation. Follow-up should then be made with Form CA-3.
What is form CA-1 or CA-2?
Form CA-1 is used for a traumatic injury (a medical condition resulting from an incident or activity occurring during one work shift). Form CA-2 is for an occupational disease (a medical condition resulting from an incident or activity occurring over more than one work shift).
What is a CA 2 form used for?
This form is used if the employee has sustained an occupational disease as a result of job duties.
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What is DoL CA-2?
DoL CA-2 is a form used to report a claim for compensation for a work-related injury or illness under the Federal Employees' Compensation Act (FECA).
Who is required to file DoL CA-2?
Federal employees who have sustained an occupational illness or injury while performing their job duties are required to file DoL CA-2.
How to fill out DoL CA-2?
To fill out DoL CA-2, the employee should provide their personal information, details of the injury or illness, the date and circumstances under which it occurred, and any medical information as necessary. It is important to follow the instructions provided on the form carefully.
What is the purpose of DoL CA-2?
The purpose of DoL CA-2 is to formally document and submit a claim for benefits related to a work-related injury or illness, allowing the Department of Labor to evaluate the situation and make decisions regarding compensation.
What information must be reported on DoL CA-2?
Information that must be reported on DoL CA-2 includes the employee's name, contact information, job title, a description of the injury or illness, the date it occurred, any witness information, and details about medical treatment received.
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